title: Acute lower gastrointestinal bleeding management in Portugal: a multicentric prospective 1-year survey.
abstract: BACKGROUND
  Acute lower gastrointestinal bleeding (ALGIB) is a common event, which consumes considerable human and economic resources. Its incidence is expected to rise in the coming years due to an increasing aging population.
  
  
  METHODS
  Multicentric prospective analysis of patients was carried out with ALGIB in 13 Portuguese hospitals from April 2008 to May 2009, using a protocol designed by the French Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux. Statistical analysis was carried out with SPSS 16.0.
  
  
  RESULTS
  In a total of 371 hemorrhagic events in 364 patients (51.4% men, mean age: 72 years), 28.4% patients showed hemodynamic instability and 54.2% were under single/combined medication with antiaggregants/NSAIDs/heparin/anticoagulants; blood transfusion was administered in 34.8% of patients. Sigmoidoscopy was the first endoscopic procedure performed in 61.3% of patients and rectal enema was the first method of bowel preparation in 67.3% of them. Endoscopic hemostasis was performed in 22.2% of all cases with efficacy ranging from 84.6 to 96.2%. Most frequent diagnoses were ischemic colitis (23.7%), diverticulosis (20.8%), and colorectal malignancies (12.4%). Surgery was needed in 8% of patients, and global mortality rate was 2.2%. Risk factors for poor outcome on multivariate analysis were heparin use before bleeding (hazards ratio: 10.6; 95% confidence interval: 0.94-119.48) and in-hospital bleeding (hazards ratio: 5.6; 95% confidence interval: 1.01-19.70).
  
  
  CONCLUSIONS
  ALGIB seems to occur frequently in Portugal with a low mortality rate. Previous heparin use and in-hospital bleeding are associated with worse prognosis. Our management relies on early endoscopic examinations, which are highly available, safe, and accurate. A successful endoscopic therapeutic approach was possible in one fifth of the patients.
authors.affiliation: Hospital de Santo André, E.P.E., Rua das Olhalvas-Pousos, Leiria, Portugal. brunoarroja@gmail.com
authors.forename: Bruno
authors.initials: B
authors.lastname: Arroja
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cremers
authors.forename: Rui
authors.initials: R
authors.lastname: Ramos
authors.forename: Cláudia
authors.initials: C
authors.lastname: Cardoso
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Rego
authors.forename: Ana
authors.initials: A
authors.lastname: Caldeira
authors.forename: Liliana
authors.initials: L
authors.lastname: Eliseu
authors.forename: João Dinis
authors.initials: JD
authors.lastname: Silva
authors.forename: Luísa
authors.initials: L
authors.lastname: Glória
authors.forename: Isadora
authors.initials: I
authors.lastname: Rosa
authors.forename: José
authors.initials: J
authors.lastname: Pedrosa
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D003625:Data Collection; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult